Atrial Fibrillation Catheter Ablation: Electroporation Against High-Power Short Duration Radiofrequency

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Pulmonary vein isolation (PVI) is essential for managing symptomatic atrial fibrillation (AF).
• Emerging ablation technologies include pulse-field ablation (PFA) and high-power short-duration (HPSD).
• Comparative outcome data for PFA and HPSD are currently limited.

Purpose of the Study:

• To compare the efficacy and safety of PFA versus HPSD for PVI in patients with symptomatic AF.
• To evaluate procedural outcomes, including recurrence rates and complications.

Main Methods:

• A retrospective analysis of 101 consecutive patients undergoing PVI with PFA or HPSD.
• Data collected included demographics, procedural details, and AF recurrence post-blanking period.
• Comparative statistical analysis was performed with a significance level of P<0.05.

Main Results:

• HPSD demonstrated significantly lower fluoroscopy time compared to PFA (P<0.001).
• PFA was associated with a higher rate of posterior wall isolation (PWI) (36% vs 11%, P=0.004).
• Overall AF recurrence was 25% (10 PFA, 15 HPSD; P=0.06), with a single major complication (cardiac tamponade) in the PFA group.

Conclusions:

• Both PFA and HPSD are feasible and safe for PVI in AF patients.
• PFA demonstrated a trend towards lower AF recurrence, particularly when PWI was achieved.
• Further real-world data are needed, but both techniques appear efficient with low recurrence rates.